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Why You Might Get a Superbill for Therapy

Aja Evans, LMHC
Written by Aja Evans, LMHC
Published on August 24, 2022

Key takeaways:

  • A superbill is a document that shows a list of services you received from a healthcare provider. 

  • You may need to submit a superbill to your insurance company to receive reimbursement for services. 

  • Talk to your therapist and insurance provider about the process for receiving and submitting a superbill.

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Beginning therapeutic services with a board-certified mental health provider can feel daunting. There are a few questions that need to be answered before you begin therapy. One is finding out if your chosen therapist takes your insurance. 

Before you begin treatment, you can check your insurance company’s website to see which therapists are in your network. You can also schedule a consultation with a mental health professional to check if they accept your insurance. 

Therapists often encourage clients to call their insurance carrier and learn what out-of-network benefits they have. If you decide to work with a therapist who is out of network, they may offer the option of using a superbill to help you get reimbursed (paid back) for your services. 

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How does a superbill payment work?

Typically, superbills are provided to clients and insurance companies that are out of network. 

If a therapist is out of network, they are not connected to your insurance carrier. That means treatment and sessions may not be covered by insurance. 

As such, your therapist won’t submit for payment to your insurance company. Instead, you can request to be reimbursed by your insurance company for a part of your costs. A superbill is your key to doing this.

You can contact your insurance provider to learn if you have out-of-network benefits. Medicare recipients do not have out-of-network benefits. It is important to know what your benefits are before beginning treatment. Also, ask if you’ll need prior authorization for out-of-network services.

If your insurance provider confirms that you have out-of-network benefits, you may be reimbursed for some of the costs you paid out of pocket.

Why do some therapists use superbills?

A therapist who doesn’t accept your insurance may provide a superbill to submit to your insurance company. A superbill shows an itemized list of services that you have received from an out-of-network provider. It’s like a detailed invoice or receipt. 

A therapist may provide you with a superbill — a specific document required by an insurance company — that allows you to seek reimbursement for an out-of-network provider. A large number of mental health professionals — including therapists and psychiatrists — don’t accept insurance.

Do I have to pay out of pocket for therapy up front?

Your therapist decides how and when they like to receive payments. During a consultation, it is important to ask about how they take out-of-pocket payments. For example, some mental health providers may require payment at the end of each appointment. While others may require payment at the end of each month. 

How much can I expect to be reimbursed after I submit my superbill?

Your insurance company will process your reimbursement according to the details of your plan. 

Based on your insurance carrier’s policies and your plan, several factors determine how much you may be reimbursed. These factors include:

  • The amount allowed for a therapy service based on what your insurance company would pay for an in-network therapist

  • Your out-of-network benefit level

  • Whether you have met your out-of-network provider deductible for the year

  • Your coinsurance rate for out-of-network providers (the percentage of charges your insurance company expects you to pay)

When you put all these factors together, here’s an example of what you might expect to be reimbursed by your insurance company:

  • You paid your therapist $120 for a 45-minute therapy session out of pocket and submitted a superbill to your insurance carrier.

  • Your insurance company decides the amount allowed for this service is $100, which is the maximum they will consider for reimbursement.

  • Your plan determines that your coinsurance is 40% for this therapy session (or $40).

  • You have met your deductible for the year and are therefore eligible to be reimbursed.

  • When processed, your insurance carrier will reimburse you $60 for your therapy session.

In most cases, your insurance company won’t reimburse 100% of what you paid to your provider. On average, people who see an out-of-network therapist pay $60 per session. Depending on where you live and your provider’s fees, this can be much higher.

Who creates the superbill?

The therapist or mental health professional you are receiving services from creates the superbill. There are different types of providers who offer mental health treatment:

  • Psychologists

  • Counselors and psychotherapists (therapists)

  • Clinical social workers

  • Psychiatrists

  • Psychiatric nurse practitioners

  • Mental health or substance use clinics or facilities

Sometimes, other types of healthcare professionals will provide you with a superbill. For example, you may need to submit a superbill for physical therapy.

They may offer superbills monthly. But, you will need to talk to your therapist to find out when you should expect to get your superbill. 

A therapist can agree with the client to give them a superbill or not. But, they don’t have to provide one.

Do I have to ask my therapist for my superbill, or do they send it automatically?

Your therapist will choose how you receive your superbill. First, it is important to know if your therapist is willing to and can provide you with a superbill. You can ask your therapist about the process for using superbills during your consultation. 

The therapist has options for how they give out superbills. Your provider may have an electronic medical record that sends out a superbill. They may also have a system that gives clients access to download the superbill through a portal. 

What information is required on a superbill?

Insurance carriers have specific requirements for how they want treatment providers to complete superbills. If any information is missing, the insurer may deny the claim or follow up to get more information before they send payment. 

Here are some common items that are typically included on a superbill: 

  • Client contact information: This may include name, address, date of birth, phone number, and any unique identifiers requested by the insurer. 

  • Provider information: This may include the provider’s name, location of practice, state license number, phone number, and email address. The provider should also include their 10-digit National Provider Identification (NPI) and employer identification number (EIN) for tax purposes.

  • Your diagnosis: Your insurance company needs to know why you needed mental health services. So, a superbill needs to include your diagnosis in the form of an ICD code. The International Classification of Diseases (ICD) diagnostic code shows what a client is being treated for and helps the insurance company validate that treatment is medically necessary.

  • CPT code: The Current Procedural Terminology (CPT) code is used by healthcare providers to describe specific medical and diagnostic services that a patient receives. This tells insurance companies what kind of services you receive, such as a 45-minute individual therapy session of a 90-minute initial consultation with a psychiatrist.

  • Dates of service: The provider should include all dates they worked with the client. If there are multiple dates of service on the superbill, the most relevant procedure code should be listed by each date.

  • Itemized list of costs: The service amount should be included next to each procedure code. The total balance should reflect the costs of all services performed. The service provider should also include any out-of-pockets costs that were paid by the client.

  • Referrer identification: The therapist or other type of treatment provider must include the contact information of the healthcare provider that may have referred the client (if applicable).

You can ask your insurance company for a list of what is required on a superbill before submitting it. And if anything is missing, you can ask your provider to update your superbill.

What do you do with your superbill once it’s filled out?

If your therapist provides you with a completed superbill, you can submit it to your insurance provider. Your insurance provider should give instructions on how to submit a superbill. Follow the guidelines and call your insurance provider if you have any questions. 

Below are some common ways to submit your superbill: 

  • Upload through insurance company portal (look for a “submit claims” option)

  • Mail in your completed information

  • Send a fax

Once your superbill has been accepted, the insurance carrier will send payment. Most of the time, your insurance company will reimburse you directly.

Is there a time limit in submitting my superbill for reimbursement?

Yes, but it depends on your insurance provider. It is important to check with your insurance carrier for their specific time frame. These guidelines can also be set by state health insurance laws. Typical time limits can range for 90 days to a year.

What happens if my insurance company denies my superbill?

If your insurance company denies your superbill, first find out why. Your insurance company must explain why your claim was denied. Look for the reason in your explanation of benefits (EOB).

There can be many reasons why your superbill claim was denied. These can include:

  • Missing information on the superbill

  • Incorrect billing or diagnosis codes

  • Claim was submitted outside the time limit

  • Lack of coverage for submitted services

  • Determination that the services aren’t medically necessary

If your claim for reimbursement is denied, you have several options. If your superbill or claim was missing information, you may need to resubmit a corrected claim. Then, your insurance company can reprocess it.

You can also appeal a denied claim. Your insurance company must let you know the process for appealing the decision. First, you’ll appeal to your insurance company. This formally asks your health plan to reconsider your claim. 

If your insurance carrier denies your claim again, you may have the option to appeal to your state’s insurance regulators. This allows you the opportunity to have your claim reviewed by an independent party.

The bottom line

Superbills allow you to receive reimbursement from your insurance carrier for paid therapy services. It is important to talk to your insurance provider before beginning therapy to understand their process for reimbursement. 

If you receive services from an out-of-network mental health provider, it’s important to ask the right questions so you won’t get any unexpected bills. Ask your therapist if they can provide you with a superbill for reimbursement. If not, you will not be able to get reimbursed.

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Aja Evans, LMHC
Written by:
Aja Evans, LMHC
Aja Evans, LMHC, is a board-certified, licensed mental health counselor based in New York City. She has over a decade of experience working in various mental health settings.
Charlene Rhinehart, CPA
Charlene Rhinehart, CPA, is a personal finance editor at GoodRx. She has been a certified public accountant for over a decade.

References

AAPC. (2021). What is ICD-10?

American Medical Association. (n.d.). CPT® codes.

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Argus Medical Management, LLC. (2013). Insurance timely filing limits.

Benson, N. M., et al. (2020). Prices and cost sharing for psychotherapy in network versus out of network in the United States. Health Affairs.

Centers for Medicare & Medicaid Services. (2021). National Provider Identifier Standard (NPI).

Centers for Medicare & Medicaid Services. (2022). Medicare mental health. Medicare Learning Network.

Davenport, S., et al. (2019). Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement. Milliman.

Garrett, P., et al. (2011). EMR vs EHR – What is the difference?

HealthCare.gov. (n.d.). How to appeal an insurance company decision.

HealthCare.gov. (n.d.). Out-of-network copayment.

National Alliance on Mental Illness. (2020). Types of mental health professionals.

Xu, W. Y., et al. (2019). Cost-sharing disparities for out-of-network care for adults with behavioral health conditions. JAMA Network Open.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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